Endoscopic Ear Surgery E-Book ISBN: Increasingly used as an adjunctive tool in the diagnosis and management of ear disease, middle ear endoscopy has . Endoscopic Ear Surgery: Principles, Indications, and Techniques: Medicine & Health Science Books @ fernlowlitiltsi.ga From the unique anatomy and pathophysiology of the middle ear through diagnosis, surgical indications, procedures, and instrumentation, this book is.
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Thieme E-Books & E-Journals. 1 Starting off with Endoscopic Ear Surgery. Full Text 6 Radiological Considerations for Endoscopic Middle Ear Surgery. fernlowlitiltsi.ga fernlowlitiltsi.ga Endoscopic ear surgery. Endoscopic Ear Surgery by Natasha Pollak, , available at Book Depository with free delivery worldwide.
In this article, Elliott Kozin and Daniel Lee review recent studies that investigate safety concerns associated with the emerging field of endoscopic ear surgery. The field of otolaryngology may be experiencing a paradigm shift towards the use of endoscopes to perform middle ear surgery. The wide-angle view and high-resolution image quality provided by rigid endoscopes allows for vastly improved visual access to outer and middle ear pathology using minimally invasive surgical portals Figure 1.
Conventional binocular microscopy is a well-established and safe modality to visualise the middle ear, but often relies on a post-auricular incision and bone removal to access complex disease. Figure 1A. The four TM quadrants are clearly visualised: 1-anterior-inferior, 2-anterior-superior, 3-posterior-superior, and 4- posterior-inferior.
The promontory of the cochlear P and round window niche RW are seen through the translucent posterior TM. Arrow — lateral process of the malleus. The blue lines intersect at the umbo of the malleus. Over the past three years, there has been a rapid increase in the use of the endoscope to perform ear surgery endoscopic ear surgery or EES. Early adopters of EES over the past decade have faced criticism that parallels the experiences of endoscopic sinus surgeons in the s.
Current barriers to widespread adoption of EES include: 1 no robust retrospective or prospective data demonstrating that EES outcomes are comparable or superior to the microscope, 2 only a handful of otolaryngology programmes worldwide that offer live exposure or hands-on courses on EES to residents, fellows and surgeons in practice, 3 limited access to high-definition endoscopic imaging technology at some centres, 4 decreased availability and selection of instrumentation for EES, and 5 most senior otolaryngologists practising today had minimal or no exposure to endoscopic sinus surgery during training, limiting familiarity with equipment and endoscopic techniques.
Heat transfer during endoscopic ear surgery Essential equipment for EES includes a light source and rigid endoscope coupled to a 3 chip high-definition HD camera and video monitor. The rigid endoscope diameters commonly used for ear surgery are 2. As the diameter expands, image quality improves and the visual field widens as more light is transmitted to the operative field.
However, larger endoscopes decrease the working space available for additional instruments and increase the transfer of radiant energy to surrounding tissues. Typical endoscope shaft lengths in middle ear surgery are 11cm, 14cm, and 18cm. In addition to the association of endoscope size on light transmission to the middle ear, the choice of light source will also affect thermal gradients during surgery.
There are three types of light sources used during endoscopic surgery: halogen, xenon and light-emitting diode LED. Figure 1B.
Observe the pyramidal eminence 1 , incudostapedial joint 2 , sinus tympani 3 , promontory 4 , ponticulus 5 , and subiculum 6. Image following removal of scutum. Several studies have documented elevated temperatures in the middle ear due to heat transmission from fibreoptic light source to endoscope tip [2,3].
Our research group at the Massachusetts Eye and Ear Infirmary MEEI investigated the magnitude of rigid endoscopic heat transfer in a cadaveric endoscopic ear surgery model .
Infrared imaging was performed to assess radiant exposure to surrounding tissues thermal gradient.
We also demonstrated that the temperature decreased rapidly within 20 to 88 seconds of turning off the light source or applying suction Figure 3. Figure 2. Temperature elevation is directly proportional to proximity of the endoscope to the round window sensor with Xenon light source. A-E: Rapid temperature elevation after light source is turned on within seconds. Temperature plateaus quickly. After light source is turned off, there is a rapid decline in temperature within seconds.
Modified from Kozin et al. Figure 3. Suction results in robust cooling of the middle ear space.
In a human temporal bone heated to body temperature, Xenon light sources were turned, and the expected rapid rise in temperature was demonstrated.
Suction was positioned next to the endoscope tip, which resulted in rapid temperature decreases to below baseline temperature.
In a complementary study, Aksoy et al. In the study, 25 male guinea pigs were exposed to heat from halogen or Xenon light sources for varying periods of time. Standard audiometric testing, including distortion product otoacoustic emissions DPOEs and auditory brainstem responses ABR were conducted on all animals at the beginning of the study, at the end of surgery, and two hours after surgery.
Thermocouple thermometer readings showed that, after the first minute, the Xenon light source generated significantly more temperature rise than a halogen light source. The surface temperatures of all endoscopes returned to normal approximately one minute after light sources were turned off. Additionally, investigators found a slightly decreased temperature difference when using a 3mm compared to a 4mm diameter endoscope.
Taken together, studies by Kozin et al. This fact is already well understood by sinus surgeons who avoid putting endoscope tips on drapes as they are a potential fire hazard.
All studies demonstrate that using the light source at sub-maximal settings as specified by the manufacturer and frequent cooling techniques, e. Potential ototoxicity of anti-fog solution While most otologic surgeons do not routinely use anti-fog solution, it is widely used in endoscopic sinus surgery. Anti-fog solution is used to reduce fogging or blurring of the tip of the endoscope due to temperature differences between the endoscopic lens and the warmer surrounding sinus cavity or middle ear.
Anti-fog solution typically consists of alcohol, surfactants, glycerin and water. In a recent study, the ototoxicity of a commercially available anti-fog solution was examined in a guinea pig model .
It is also helpful to otolaryngology residents during their otology block. This book is valuable to anyone performing ear procedures in the operating room or in the office. Table of contents Foreword by John H. Paparella, MD Contributors 1. Management of the Mastoid System Hamed Sajjadi 8.
Review quote "The art of this book is to very convincingly demonstrate applications and indications for endoscopic ear surgery and to consider future developments. The content is of course superbly illustrated and the layout does make "cherry picking" one's favourite topics easy. The description of the instrumentation and operating room set up I found thought provoking and, as a result, I detect the "Wind of Change" locally. Three chapters on CSOM will surely have the greatest relevance for our readers and there is excellent coverage of retraction pockets, sinus tympani cholesteatoma and the "Second Look" managed endoscopically.
Later chapters range from "Office based" minor surgery to posterior fossa surgery. The latter is a lengthy chapter and the photography is superbly reproduced.
This is an excellent book, tackling something a bit "different" and which should influence clinical practice. About Natasha Pollak Dr. Learn about new offers and get more deals by joining our newsletter. Sign up now. Follow us.